Now This is the Tale of our Castaways
How medical care for women is withheld by circumstance and law
The Organization of Economic Cooperation and Development (OECD) has 38 member states, including most of the world’s wealthy nations and a number of poorer ones. The organization hosts massive databases on economic and social indicators which you can use to compare outcomes between countries.
For instance, the U.S. ranks 30th in life expectancy among member states, sandwiched between the Slovak Republic and Colombia; 32nd in infant mortality, between the Slovak Republic and Chile; and 28th in maternal mortality, with a rate about 50% higher than Turkey above us, and 0.1% lower than Costa Rica below. (The OECD health outcomes data are available here.)
Among the primary reasons the U.S. fares so poorly are that we don’t have universal healthcare, and we don’t have robust social welfare systems. Lower-income people here get nothing like the medical care afforded our wealthy and upper-middle classes; women, particularly women of color, get the worst of a bad system in terms both of standards of care and availability.
Horrid outcomes at the bottom and the margins of our society translate into very bad overall outcomes for the country as a whole; even within the country the rates of infant and maternal mortality are wildly disparate among states and among demographics.
CT News Junkie, a 17-year old news and data site in Connecticut, popped up when I went looking for more information about maternal and neonatal health care availability and standards of care. They’ve done a county-level breakdown of states in which the largest percentage of women live in what they characterize as maternal health care deserts.
Stacker analyzed data from the Health Resources and Services Administration‘s Area Health Resource Files and merged it with county-level birth data collected by the National Vital Statistics System to calculate what percentage of a state’s population lives in counties without access to maternal health care and how many births in each state are to parents who live in maternal health care deserts. For populations, we utilized 2020 census population data across sex and age to include county-level demographic information and more deeply compare racial disparities, although maternal health care deserts have a disproportionate impact on people between the ages of 15–44 who can become pregnant.
The 15 states with the highest rates of women living in maternal care deserts won’t surprise you: Idaho is 15th worst, and Mississippi is number one. In between are states including Kentucky, Louisiana, both Dakotas, and Alabama. The writers further note that “[c]hallenges such as poverty, limited access to transportation, lack of insurance, and systematic racism can put families at risk of poor maternal and infant health outcomes even in areas with access to maternal care.”
First printed in Bloomberg Business Week, this story in Texas Monthly, about a West Texas physician trying to cover an underserved population in his huge corner of the state, provides a more intimate look at what both doctors and patients face when medical care in general and maternity care particularly is hard to come by. And Texas isn’t even among the 15 worst states for babies and pregnant women identified above.
[Adrian] Billings is a family doctor, one of only a handful in this part of West Texas. He offers a one-stop shop for his patients’ ailments: heart murmurs, kidney stones, et cetera. Most of the time he works in Alpine or the nearby city of Marfa. But he makes the weekly drive to Presidio, because without doctors like him, it wouldn’t have medical care [emphasis mine]. There’s no hospital and no full-time doctor. His clinic, which opened in 2007 with the help of government grants, is the only access residents have to even a local pharmacy.
…
On a sunny Thursday in early June, Billings wheeled out a sonogram machine donated by a charity a few years ago and confirmed that a young woman was pregnant. She was happy—she wants to have a baby. But in West Texas, that’s easier said than done.
Billings explained, as he does to all pregnant patients, that he can use the machine to detect a fetus, but he can’t do much else. The clinic doesn’t have a sonographer with the expertise to ensure one is developing properly. Normally he’d recommend the woman drive the hour and a half to Big Bend Regional Medical Center, Alpine’s hospital, for her prenatal needs and to give birth. But for more than a year, Big Bend’s labor and delivery unit has closed routinely, sometimes with little notice. Some months it’s been open only three days a week.
The wave of abortion restrictions and effective bans rolling across the country faces women who don’t want to be pregnant or who need an abortion from medical necessity, with straits even more dire than those who, like Dr. Billings’ patient, do want a baby. At the same time the restrictions put more pressure on maternity care providers who may not be willing to risk treating conditions that require procedures resembling abortion, like removing the remnants of a failed pregnancy. From Texas, again:
Last year, a 35-year-old woman named Amanda, who lives in the Dallas-Fort Worth area, had a miscarriage in the first trimester of her pregnancy. At a large hospital, a doctor performed a surgical procedure often used as a safe and quick method to remove tissue from a failed pregnancy.
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Eight months later, in January, Amanda, who asked to be identified by her first name to protect her privacy, experienced another first-trimester miscarriage. She said she went to the same hospital, Baylor Scott & White Medical Center, doubled over in pain and screaming as she passed a large blood clot.
But when she requested the same surgical evacuation procedure, called dilation and curettage, or D&C, she said the hospital told her no.
Abortion restrictions or bans can only make the already lamentable U.S. maternal and infant mortality figures even worse. Women who cannot get treatment that includes abortion or even, like Amanda, the best treatment for a miscarriage, are going to suffer and die. Women who cannot find good OB/GYN care within a reasonable distance from their homes are going to suffer and die, and care will become even less accessible when, as has happened with the hospital in Alpine, Texas, those departments lose staff to the point where they can’t remain consistently available.
The U.S. health care “system” is built to generate the kinds of results discussed here. Private insurance, along with Medicare and Medicaid to varying degrees, are meant to make money—Medicare Advantage plans control an increasing percentage of the Medicare market, as do for-profit managed care plans with Medicaid—and so are most medical facilities. Where a profit can’t be found, too often neither can adequate medical care.
Universal health care will help address these issues, as will funding hospitals and clinics in medical deserts, without which health care can’t be called universal. A social welfare system that encourages people to get appropriate medical care, that allows them paid time off when they’re sick, that penetrates the veil of ignorance erected especially by reactionary state and local governments, will help.
But we don’t have those. Republicans are hysterically opposed, and so are enough Democrats to render invisible any path toward those goals. We’ve hanged everyone out to dry, the poor most particularly and women most of all, and women of color most of all among those.
Medical and social activists are chipping away at these issues, but we need wholesale change to stop people dying or withering away in the present. Can we get to that?
(Contributors to this post include Thao and the Get Down Stay Down’s Temple; Courtney Barnett’s Things Take Time, Take Time; Clairo’s Sling; and Sonny Rollins’ Way Out West.)